Being Mortal, by Atul Gawande

In Being Mortal, Gawande tackles a significant challenge of his profession: how medicine can improve life, as well as the process of its ending. In other words, he asserts that medicine can comfort and enhance our experience even to the end, providing not only a good life but also a good end. 

Being Mortal is a valuable contribution to the growing literature on aging, death and dying.  Despite advances in medicine, he calls for a radical transformation in how we approach the end of life.  He states that nursing homes are preoccupied with safety, pinning patients into railed beds and wheelchairs;  hospitals isolating the dying, checking for vital signs long after the goals of cure have become moot; and doctors, committed to extending life, continuing to carry out devastating procedures that in the end extend suffering.

His early description of how the body decays with age is nothing if not sobering. From the news that an elderly person’s shrinking brain can actually be knocked around inside the skull to the way a tooth can determine a person’s age, he goes through a litany of descriptions of how the body goes through scary decaying changes.

He states that it is unfortunate that the number of doctors willing to become geriatricians is shrinking, primarily because the field is not as lucrative as most other specialties and because it provides so little instant satisfaction, and requires such work as a detailed, lengthy examination of callused old feet. Patients are usually deaf and forgetful, can’t see, have trouble understanding what the doctor is saying, have not one complaint but fifteen, have high blood pressure, diabetes and arthritis. “There’s nothing glamorous about taking care of any of those things," he writes.  But, he contends that patients who receive good geriatric care stay happier and healthier, particularly those who can remain at home and aren’t forced into a nursing home.

At the end of the book, he states that, “The debate is about what mistakes we fear most – the mistake of prolonging suffering or the mistake of shortening valued life.” While posing that there are no perfect solutions, he asks that medicine commit itself to creating better options and making choices with the goal of a purposeful life in mind.

Aside from suggesting it be read by physicians, I also strongly believe it should be read by everyone over sixty, and well as their children who will like be involved in the decisions that need to be made toward the end of life. —Ken Johnson